The information of 349 cases of multiple sclerosis, seen in a neurological department over a twenty-year period and followed up for a mean of nine years, was analysed by computerized data processing. The mean age at onset was 30.0 years for the remittent onset types (82 per cent cases) and 37.3 years for the progressive onset types (18 per cent cases). During the course of the disease the age of the 'pure relapse' stage was 29.2 years, of the relapse with sequelae stage 33.9 years and of the progressive phase 38.0 years. The interval between the first two relapses in the remittent-progressive type was important, the shorter the interval the sooner the progressive phase occurred. The relapses tended to increase in frequency before the progressive phase started. Using an actuarial graph, 50 per cent of cases could be expected to be moderately disabled (still ambulatory) in six years, and severely disabled (not ambulatory) in eighteen years and dead in thirty years. Combining a disability score and the duration of the disease prognostic factors could be studied. A late onset of the disease, a short interval between the first two relapses and the occurrence of the progressive phase were associated with a poor outcome. Sex of patient, the symptomatology of the initial relapses, and the constituents of the CSF had no prognostic value.

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SUMMARY The IgG pattern in CSF was studied in 11 patients with multiple sclerosis who exhibited an oligoclonal banding upon thin-layer polyacrylamide gel isoelectric focusing followed by silver stain of unconcentrated CSF. Each patient received beta-interferon intrathecally during a 2 month period. No modification was observed over a 6 month period. In addition, the oligoclonal pattern was remarkably unique for each individual representing a typical "fingerprint" which allowed the identification of any single CSF.

Cerebrospinal fluid (CSF) cytocentrifugation was performed for plasma cells' demonstration in parallel with white cell count (WCC) and quantitative protein assays. Over a 5-year period, 154 consecutive multiple sclerosis (MS) patients were studied and compared to 28 other inflammatory neurological disease, 85 non-inflammatory neurological disease and 29 non-neurological disease cases. CSF cytology was easy to perform, gave definitive results within 2 h and was abnormal in 80 MS patients, 26 of whom had a normal WCC. Its sensitivity in MS was 0.57, i.e. higher than for WCC (0.45) but lower than for IgG index (0.70) and IgG synthesis rate (0.71). Its specificity was 0.86, not significantly different from specificity of WCC, IgG index and IgG synthesis rate. Plasma cells demonstration in MS CSF was neither a disease activity nor a prognosis marker. It was significantly correlated with pleiocytosis and intrathecal IgG synthesis. If these morphologically defined plasma cells are actual B cells, they could represent circulating individuals of the lymphocyte clones active in MS plaques and have a pathogenetic significance.

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